肾脏科患儿合并侵袭性真菌感染临床分析

Clinical analysis of invasive fungal infection in children of nephrology department

目的 分析肾脏科住院患儿合并侵袭性真菌感染的临床特点。方法 回顾性分析 1999年至2014年27例肾脏科住院患儿并发侵袭性真菌感染的临床资料。结果 9例为泌尿系念珠菌感染，8例为肺孢子菌病肺炎，4例侵袭性肺曲霉菌病和1例侵袭性泌尿系曲霉菌感染，2例新型隐球菌脑膜炎，2例为肺念珠菌病，1例为肺丝状真菌感染。均存在基础病变，其中10例为原发性肾病综合征，7例继发性肾病综合征，6例伴有泌尿系统发育畸形，4例为〈32周早产儿和低出生体质量儿。均使用过抗生素。17例患儿有接受糖皮质激素和/或免疫抑制剂史。16例有侵入性操作史。27例均有发热症状，14例出现喘憋，7例进行性呼吸困难和呼吸衰竭，5例合并多脏器衰竭。8例肺孢子菌病患儿胸部CT示弥散磨玻璃影伴“马赛克”征；4例肺曲霉菌病患儿见肺多发结节影、易形成空洞。2例肺念珠菌病患儿病灶边缘模糊、浓淡不均，呈小斑片影，位于双肺中下野、不累及肺尖。23例接受足疗程抗真菌治疗，经治疗后16例痊愈，3例好转，4例死亡。4例放弃治疗。结论 长期使用激素和免疫抑制剂、不恰当使用抗生素、低出生体质量早产儿、泌尿系统发育畸形、侵入性操作等是侵袭性真菌感染的易感因素。不同的真菌感染影像学有不同特点，尽管不具备诊断特异性，但其相对特征性表现可为早期诊断提供一定的线索。

Objective To explore the clinical features of invasive fungal infection in 27 children treated at nephrology department between 1999 and 2014. Methods Twenty - seven cases of invasive fungal infection at nephro- logy department were analyzed retrospectively. Results Candida urinary infection was found in 9 cases, pnenmocystis carinii pneumonia were found in 8 cases,invasive pulmonary aspergillosis and urinary aspergillosis found in 4 cases and 1 case respectively, cryptoeoccus neoformans meningitis and pulmonary candidiasis found respectively in 2 cases, and pulmonary filamentous fungal disease was found in 1 case. These 27 cases showed different features of illness ： 10 primary nephrotic syndrome ,7 secondary nephrotic syndrome ,6 malformation of urinary development and 4 preterm birth 〈 32 weeks gestational age with low birth weight. All of the cases had the history of taking antibiotics. Seventeen cases of them had used corticosteroid and cytotoxic drugs in a long - term. Sixteen cases had experienced invasive procedures. All children had fever in varying degrees, 14 cases showed gasp ,7 cases had progressive hypoxia and respiratory failure, and 5 cases developed into multiple organs failure. Chest computed tomographic （ CT ） imaging data showed diffuse ground -glass opacity with mosaic sign of pneumocystis earinii pneumonia（ 8 cases）. The features of pulmonary asper- gillosis included multiple nodules and cavity in bilateral lungs （4 cases）. The radiologie findings showed patching lesions with indistinct edge and uncertaincd density of bilateral middle - lower lung fields with pulmonary candidiasis （ 2 cases）. Full dose of antifungal drug was given to 23 cases of them, 16 cases recovered completely,3 got better,4 cases died. Four cases gave up full dose antifungal therapy. Conclusions Long - term use of corticosteroid and cytotoxic drugs, use of broad - spectrum antibiotics, invasive therapies, such as indwelling centralvenous catheters, endotracheal intubation with mechanical ventilation, and preterm birth with low birth weight were risk factors in predicting invasive fungal infection. Chest CT findings were different among these cases. Even though not specific, the relatively differences were helpful to the differential diagnosis of these diseases.